Retail and Urgent Care Articles
Urgent care centers wrote the most inappropriate antibiotic prescriptions for viral respiratory illnesses. They were followed by the ED, medical offices, and finally by retail health clinics.
In this single center, 27% of urgent care to pediatric emergency department transfers were likely unnecessary and resulted in discharge with no ED resource utilization.
Acetaminophen use during late pregnancy was associated with premature ductus arteriosus closure in these two cases.
In women with confirmed first trimester pregnancy loss, the combination of mifepristone 200mg orally and misoprostol 800μg vaginally at 24 hours vs misoprostol 800μg alone resulted in improved complete expulsion at day 8 (NNT = 6) and decreased need for surgery: 9% vs 24%.
This large RCT found tamsulosin was of no benefit for kidney stone passage at 28 days, regardless of size or location.
Oral fluconazole is safe to use in pregnancy.
Tachypnea, chronic ulcers, prior MRSA colonization, and prior cellulitis in the past 12 months were all associated with an increased risk of oral antibiotic failure for treatment of non-purulent cellulitis.
Nitrofurantoin was clearly superior to fosfomycin for uncomplicated UTI in adult women.
Nuisance bleeding in patients with atrial fibrillation on oral anticoagulants did not portend subsequent major bleeding or increased risk for stroke/systemic embolism.
Influenza killed 675 children from the 2010-11 flu season to the 2015-16 season. Infants under 6 months had the highest incidence of mortality. Encourage everyone to get vaccinated. Antiviral treatment is encouraged in all children under 2, all patients with severe illness, and all hospitalized patients regardless of whether or not the duration of illness exceeds 48 hours.
Sniffing an isopropyl alcohol pad was more effective at reducing nausea than oral ondansetron at 30 minutes.
Opioids were no better than non-opioid medicines for chronic back, hip, or knee pain. However, undesirable medication-related symptoms occurred more commonly among those taking opioids.
Positive responses to "red flag" screening questions for back pain warranted further investigation, though the positive predictive value was poor. Negative responses to screening "red flag" questions were useless as a screening tool for ruling out serious disease, such as fracture, infection, malignancy, or cauda equina.
The Boss-Holzach-Matter (aka Davos, self-reduction) technique was less painful than the physician-driven Spaso technique and just as successful and efficient.
Fluoroquinolone use was associated with increased risk of developing newly diagnosed aortic aneurysm or dissection.
Acetaminophen (APAP) was not inferior to diclofenac or APAP+diclofenac for acute extremity pain at 90 minutes.
This meta-analysis of 4 RCTs found anti-MRSA antibiotics in addition to I&D led to a far better cure rate than I&D alone.
Prophylactic diphenhydramine reduces extrapyramidal symptoms in patients receiving bolus anti-emetic therapy (given over 2 minutes), but not when the anti-emetic is given as an infusion over 15 minutes.
Trimethoprim (TMP) was associated with increased risk of hyperkalemia and acute kidney injury (AKI) in adults over age 65.
Children with a non-fatal drowning event who present to the ED with normal vital signs and normal SpO2 very rarely deteriorated. The 3% (2/62) who had delayed complications did so within one hour of arrival.
A probiotic, Lactobacillus reuteri DSM17938 (L.r.), helped breastfed infants with colic. Now you actually have something to tell the desperate family that comes in with a colicky but otherwise normal baby.
This may come as a shock, but when you tell patients no, it negatively impacts patient satisfaction. But that doesn't make you a bad doctor, regardless of what CMS says.
A push to use cephalexin vs cefixime for uncomplicated pediatric UTI was successful at this medical center. Whether this is an improvement in prescribing depends upon local E. coli resistance.
Broad spectrum vs narrower spectrum antibiotics for routine pediatric respiratory infections were not more effective and were associated with an increased rate of complications.
Neither morphine+ibuprofen nor either drug alone+placebo improved pain to a minimal score at 1 hour in children with acute extremity pain.
A dose of ibuprofen 400mg + acetaminophen 1000mg was as good as an oral opiate for extremity pain.
This article is a sobering reminder that mistakes with online activity can cost one's career. We know the obvious blunders, but this editorial explores 3 more subtle ways our smartphones could damage our reputations.
Codeine prescriptions for children after tonsillectomy and adenoidectomy substantially dropped after the FDA issued a black box warning over safety concerns. Still, 1 in 20 children continue to inappropriately receive codeine after T&A.
Capsaicin cream for cannabis hyperemesis has been described in adults; this is the first reported use in adolescent patients. It appeared to help, N = 2.